Many poor too rich to be in CHIPs

BOISE – Enrollments are slowly inching up in two programs designed to help more uninsured Idaho children get health insurance, but they’re still far below what lawmakers had envisioned – even though the need remains high.

“We thought people would flock to it,” said Sen. Dick Compton, R-Coeur d’Alene, the Senate Health and Welfare chairman. But, he said, “You’ve got to look at the positive side – you’ve got some people who didn’t have any insurance, and have got some coverage now. That’s good news.”

Lawmakers are hoping to get federal permission in the months ahead to ease some restrictions that are keeping many needy families out of the program.

“There’s a lot of people applying,” said Senate Finance Chairman Dean Cameron, R-Rupert. “Unfortunately, a lot of them are not able to qualify for the product for a variety of reasons. I think we’re looking for ways to reduce those barriers and to improve on what we’re offering there.”

State legislators in 2004 expanded Idaho’s Children’s Health Insurance Program to provide some limited coverage for kids from families that make just over the income limit for regular CHIP. The CHIP B program charges a $15-per-month premium in exchange for limited coverage. The Access Card program provides a $100-per-month subsidy to help pay private insurance premiums, up to a maximum of $300 per family.

There are now more than 2,200 children on the two programs, the vast majority of them on the CHIP B program. But lawmakers had originally envisioned serving at least 5,600 children through the two programs. Since they started in July of 2004, there have been more than 10,000 who have applied, and more than half haven’t qualified.

More than a thousand were turned away because their incomes were too high. While the regular CHIP program insures only those whose families make 150 percent of the federal poverty level or less, CHIP B and the Access Card program serve families who make up to 185 percent. For a family of four, that’s $35,797, compared to $29,025 for regular CHIP.

Many others were rejected because they already had insurance, so federal regulations say they’re ineligible. “They did not want people to drop private medical coverage to get on Medicaid coverage,” said Patti Campbell, senior program manager in the Division of Medicaid at the Idaho Department of Health and Welfare.

But those rules were written with regular Medicaid in mind, Campbell said, which provides full coverage at no cost to the poor and disabled. They may not have contemplated situations like Idaho’s Access Card, which actually uses partial Medicaid funding to encourage people to get private insurance.

Idaho now plans to apply for a waiver from the federal rules, though Campbell said the state asked for a similar waiver earlier and was rejected.

Compton said the current situation makes little sense, as it actually encourages people to drop their insurance and go without for a period of time, so they can then apply for the partial subsidy. “It just doesn’t make any human sense that you’d want people to be without insurance in order to get it,” he said.

There’s another federal rule that’s also hindered the program, Campbell told lawmakers Thursday in a briefing to a state health care task force. If someone applies for CHIP B or the Access Card and is found to actually qualify for regular Medicaid – meaning their income is lower – they’re required to accept the full program rather than just the partial aid.

More than 175 Idahoans, faced with that choice, have decided they’d rather not have any insurance.

“I’m not surprised by that number at all,” Cameron said. Cameron, co-chair of the health care task force, said many Idahoans don’t like the idea of being on government aid. “I bet there are at least 10 times as many individuals who haven’t applied, because they don’t want government assistance.”

Campbell said the state also is seeking a federal waiver from that rule, to allow people who are eligible for full Medicaid to instead opt for the lesser coverage.

“Some feedback I’ve been given is there is a stigma attached to a Medicaid card,” she said. “They say, ‘I want to give my doctor a private insurance card.’ “

In addition to CHIP B and the Access Card, lawmakers this past year approved another attempt to help more uninsured Idahoans get health coverage by setting up a pilot program, Access to Health Insurance, to help small businesses with the cost of premiums for their employees. So far, 40 employers and 189 employees or their dependents are participating. Another 35 employers have looked into the program, but decided not to participate.

Campbell said their main concerns were that the income limit, at 185 percent of poverty, was too low for their employees, and that they were required to pay 50 percent of premiums for the employee’s spouse as well as the employee.

The Access to Health Insurance program is limited to 1,000 covered adults, but hasn’t begun to approach that cap.

All three programs are funded by a portion of Idaho’s insurance premium taxes.

Idaho’s high rates of uninsured residents prompted lawmakers to look into starting up the various programs.